Prevention of caries around the bracket: home methods and clinical protocol

Although orthodontic treatment brings a regular and beautiful smile, one of its main challenges is the decay around the brackets and the appearance of white spot lesions on the tooth enamel. These lesions are usually formed at the place of microbial plaque accumulation, around the brackets, and if they are not controlled, they will destroy the beautiful appearance of the teeth after completing the orthodontic treatment. It is not possible to prevent caries around the bracket by regular brushing alone. This goal requires a set of targeted home behaviors, protective materials containing fluoride, and a standard clinical environment.

The cause and mechanism of decay around the bracket

Brackets, wires and orthodontic elastics make the surface of the teeth uneven and cause more accumulation of microbial plaque. By consuming sugary substances, bacteria convert sugar into acid. This acid removes calcium and phosphate ions from tooth enamel and destroys tooth enamel. At the beginning, the surface of the tooth becomes cloudy and white; This is the first sign of enamel demineralization. If neglected, the white lesion turns into brown rot and then a cavity.

Effective and scientific home methods to prevent caries around the bracket

1 - Choosing the right orthodontic toothbrush Toothbrush and toothpaste are the first line of defense against caries. For orthodontic patients, the best option is: - Special orthodontic toothbrush (V‑Shape Brush) whose fibers in the middle are shorter and cleans around the bracket completely. - Interdental Brush, which is used to clean the areas between the bracket and the wire. The complete washing of the teeth from the gum line to the bracket should take at least two minutes.

2 - Use dental floss for brackets It is difficult to use regular dental floss. Special orthodontic threads (Ortho Floss) or threaders make it easier to pass the thread under the wire. Flossing between the teeth once a day prevents the accumulation of plaque and has a great effect on the health of the gums.

3- Fluoride toothpaste and mouthwash Fluoride plays a key role in enamel remineralization. Choose toothpaste with 1000 to 1500 ppm fluoride. - Night mouthwash with 0.05% sodium fluoride is recommended to control plaque. - Continuous use of mouthwash reduces the possibility of white lesions around the bracket by 50%.

4- Proper diet during orthodontic treatment Changing the diet plays a vital role: - Reducing the consumption of simple sugars: such as soft drinks, sweets and sugar gums. - Replacing snacks: such as fresh fruits, nuts and low-sugar dairy products. - Increasing consumption of calcium and phosphate-containing substances (milk, cheese, yogurt) to restore enamel. - Be careful with acidic drinks such as industrial fruit juices that lower the pH of the mouth.

5 - Maintaining oral pH with simple daily habits After each meal, rinsing the mouth with plain water helps reduce mouth acid. Chewing gum without sugar (containing xylitol) also increases the secretion of saliva and neutralizes the oral environment. Saliva is rich in bicarbonate buffers and is one of the natural enamel protection factors.

6 - The correct technique of brushing around the bracket - The toothbrush should be placed at an angle of 45 degrees to the gum line. - Clean from the bottom of the wire and bracket first, then from the upper surface. - Small circular movements cause better hair penetration around the bracket. - The chewing and back surface of the teeth should not be forgotten.

7 - Home remineralizing products (CPP‑ACP and nanohydroxyapatite) Toothpastes and creams containing casein phosphopeptide/amorphous calcium phosphate (CPP-ACP) or nanohydroxyapatite are effective in restoring enamel. Using these products at night after brushing strengthens the demineralization process.

8- Daily home care checklist for orthodontic patients - Brush your teeth two to three times a day with fluoride paste - Using special dental floss once a day - Mouthwash with fluoride at night Avoiding sticky and sweet foods - Washing the mouth after every meal - Regular visits once a month for evaluation by a dentist

Standard clinical protocol for dentists

1- Initial assessment of the risk of caries Before installing the bracket, the patient's oral hygiene should be checked. In patients with high plaque index, more detailed training and preventive fluoride therapy is necessary.

2 - Choosing an orthodontic adhesive with fluoride release Many modern adhesives release fluoride, which increases the local concentration of fluoride at the edges of the bracket. Using them is one of the effective scientific methods in reducing white waste.

3 - Apply protective sealant resin around the bracket Covering the fractured areas of enamel with resin sealant before or after attaching the bracket prevents plaque penetration. This transparent layer remains for several months and creates an invisible protection.

4- Professional fluoride therapy in the clinic After each visit or every 3 months, the patient's mouth is treated with 5% sodium fluoride varnishes. This method can reduce the chance of caries around the bracket by 60%.

5- Professional polishing and periodical scaling Plaque and white spots are cleaned with a low-speed electric tool (Polishing Cup). In addition to beauty, this work is effective in preventing the regrowth of bacteria.

6 - Continuous education of the patient Each patient should be reminded of the correct way to brush and care for brackets at each examination session. Repetition of education stabilizes health behavior.

7- Radiographic examination at specific intervals Bite‑Wing images can reveal early interdental lesions before they become visible. Early diagnosis equals easier treatment.

The role of saliva in the natural protection of teeth

Saliva not only cleans the teeth mechanically, but also contains antibacterial substances, natural fluoride and enzymes that control the growth of microbes. Lack of saliva (due to medication or stress) increases the risk of caries gives Consuming plenty of water, chewing xylitol gum and avoiding smoking help improve saliva secretion.

Early signs of caries around the bracket and early detection

Primary damage can be seen in the form of opaque white dots on the edge of the bracket. At this stage, there is still no cavity and the process is reversible. The patient should immediately inform the dentist if he sees any discoloration or roughness of the tooth surface. Continuing hygiene, using fluoride paste and cream or CPP-ACP and eliminating sugary foods can repair these points.

Home remedies in the initial stage of caries

When white spots are newly formed, home remedies are very effective: - nightly use of MI Paste or Remin Pro (containing CPP-ACP). - 0.05% fluoride mouthwash every night. - Avoiding rough brushing that makes the enamel thinner. Within a few months, the luster of the enamel returns and the possibility of the lesion's progress is eliminated.

Specialized treatments in case of progression of the lesion

If the decay reaches the brown stage or becomes pitted, specialized treatment is necessary: - Microabrasion and surface polishing: to remove the enamel surface layer. - Infiltrating resin (ICON): to fill the pores without shaving the teeth. - Composite repair: in more advanced stages. In all these methods, the goal is to restore the appearance of the tooth and prevent the further progress of caries.

Final summary

Prevention of decay around the bracket requires a combination of three factors: 1- Accurate home hygiene (toothbrush, dental floss, fluoride) 2- Controlled diet and proper oral pH 3-Regular clinical follow-up

Let's not forget that orthodontic treatment is successful only when the teeth remain healthy and stain-free at the end. Following these recommendations will make the beautiful smile bright and shiny after removing the brackets. Using the most up-to-date fluoridated materials, ion-releasing resins and personalized training for orthodontic patients, Dr. Foroghi's clinic prevents the occurrence of white lesions and decay around the bracket. In this center, the clinical protocol is set according to international standards and each patient receives a specific health plan according to the type of device and the level of caries risk. If you are looking for an experience without worrying about stains and decay during orthodontics, Dr. Foroughi Clinic in Tabriz is one of the trusted options for complete oral and dental care.

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